Background

In 1996 the Department of Health and the Irish Pharmaceutical Union completed the Agreement of Dispensing of High Tech Medicinal Products Scheme (HT scheme). The HT scheme provides for the dispensing of HT medicines (e.g., gonadorelin analogues, interferons, immunosupressants) by community pharmacists to ambulatory patients who are under the care of a hospital clinic. Operation of the HT scheme requires 5-steps: 1) Patients prescribed HT medicines at a hospital clinic nominate a community pharmacy from whom they will obtain the prescribed medicine. 2) The hospital records and submits the prescription information to a Health Board Liaison Officer. 3) The Liaison Officer notifies the patient's pharmacy of their HT medicinal requirements. 4) The pharmacy acquires the HT product from a pharmaceutical wholesaler or directly from a pharmaceutical company. 5) The pharmacist submits a HT claim/dispensing record form and the supplier delivery docket to the General Medical Services (GMS) Payment Board for reimbursement. A review of the HT scheme operation has not been conducted previously to our knowledge. Objective

The purpose of the study was to review the operation of the HT scheme from the community pharmacist's perspective five-years after its inception.

Method

All 104 community pharmacies in the North Eastern Health Board (NEHB) region were sent a postal questionnaire in November 2001 designed for this study. A second posting of the questionnaire was sent to all non-responding pharmacies in January 2002. Likert scales (1-poor to 10-excellent), multiple choice, and open-ended questions were used to elicit pharmacists' opinions about the operation of the scheme.

Result

A total of 58/104 (56%) community pharmacists responded to the survey. Ninety-three percent reported involvement in the HT scheme within the previous 6-months. The majority of pharmacists (76%; 44/51) believed the scheme was justifiable. At the time of the study 40% (20/50) of the pharmacists felt they needed further training about the scheme's administration, and 79% (41/52) further training about the HT medicines. Most pharmacists felt that HT medicinal products refrigeration storage requirements (90%; 36/40) and the capacity to store them (86%; 42/49) were appropriate in their pharmacy. Waste of HT medicines was an issue for 76% (41/54) of the pharmacists and 31% (17/54) believed that it was excessive. Overall there were 55 prescription-handling problems, and 44 claims procedure problems reported. Pharmacists rated the communication between the hospital pharmacists and the community pharmacists below average (median= 4), and cooperation between the hospital and community pharmacists just above average (median= 6). Communication, and cooperation between the NEHB and the community pharmacist were both rated above average (median= 7 and 8 respectively). Communication correlated positively with cooperation in both hospital pharmacist and NEHB interactions with community pharmacists (p=0.01).

Conclusion

The majority of community pharmacists were satisfied with the HT scheme but were concerned at the wastage of HT products and reported problems that may be related to the need for seamless communication between community pharmacists, hospital pharmacists and the health board.